Table of Content

What is PMS?

Premenstrual Syndrome (PMS), also known as Premenstrual Tension (PMT), is the name given to a collection of emotional and physical symptoms that women may experience during the luteal phase of their menstrual cycle, and which disappear shortly after the start of menses (the menstrual flow).[1] All women, at some point during their reproductive years, will experience symptoms of PMS. For around 75 percent of women, these symptoms will be mild and won’t affect their everyday life. Between 20 and 30 percent of women will suffer severe symptoms, with between 5 percent of these women suffering symptoms severe enough to have a serious impact on daily life.[2]

What causes PMS?

The exact causes of PMS are not known. It’s believed fluctuations in progesterone and oestrogen hormones and also brain chemicals may play a role, but their exact significance isn’t clear. [3]In recent studies, hormone levels appear to be the same in women whether or not they have PMS and it’s possible that women with PMS are actually more sensitive to changing levels of oestrogen and progesterone. These hormones also affect other parts of the body, including the brain and nervous system. Oestrogen can affect the levels of neurotransmitters, such as serotonin, which is known to have an effect on emotions and eating behaviour. But as to whether these effects in oestrogen, progesterone, and serotonin are responsible for the emotional aspects of PMS is still unknown. However, most researchers agree that the chemical transmission of signals in the brain and nervous system is in some way related to PMS.[4] A study published in the Journal of Disease Management and Health Outcomes purports that fluctuating oestrogen levels in particular may play an important role in the severity of PMS symptoms.[5] In addition, a 2011 study found women who suffer from severe PMS have a particular sensitivity to the hormone allopregnanolone, which occurs naturally in the body after ovulation and during pregnancy, and changes during the course of the menstrual cycle.[6] Researchers have also discovered a possible genetic link to the likelihood of PMS for women. A recent study found that the probability of identical twin girls both suffering from the symptoms of PMS is above average. They discovered that if one twin has PMS, then the other twin has a 56 percent chance of having PMS as well, without the impact of family or environmental factors.[7] There are also a number of known contributors to the severity of PMS symptoms. These include:[8]

Environmental factors that cause stress and anxiety such as grief, lack of social support and emotional distress.

Underlying medical conditions such as mental illness.

The excessive consumption of certain foods and drinks high in salt, sugar and caffeine.

Alcohol consumption and smoking. (Smokers are twice as likely to have severe PMS symptoms[9].)

Age can also impact on the severity of symptoms as it has been found that women over 30 years have a much higher risk of suffering from severe PMS.

What are the symptoms of PMS?

More than 200 physical and behavioural symptoms have been attributed to PMS, but in reality most women will experience only a few. Symptoms follow a predictable cyclic pattern that is unique to each woman. A few of the more common symptoms that are temporary and limited to the luteal phase include: [10]Physical symptoms:

Breast engorgement and tenderness

Abdominal bloating

Constipation or diarrhoea

Headache and migraine (migraine may increase in severity of PMS symptoms)

Swelling of the hands or feet

Weight gain

Clumsiness

Nausea and vomiting

Muscle and joint aches or pains

Emotional and behavioural symptoms:

Depression

Anxiety and panic attacks

Insomnia

Change in sexual interest and desire (although some women lose interest, others have a heightened drive)

How to relieve the symptoms of PMS

If PMS is mild to moderate in intensity and doesn’t require a visit to the doctor, adopting a few common sense lifestyle changes can help to reduce the physical and emotional impact of symptoms. These include:[11]

regular exercise

a healthy diet

getting plenty of sleep

learning new ways to cope with stress

not smoking

reducing alcohol consumption

In addition, some over-the-counter medications such as ibuprofen and paracetamol can assist in alleviating physical discomforts such as cramps, headaches, backaches and breast tenderness. Certain vitamins, minerals and supplements have also been shown to reduce the severity of symptoms in some women. These include:[12]

Severe PMS is more difficult to treat. Some women use the contraceptive pill to regulate their menstrual cycle and while it doesn’t necessarily alleviate emotional symptoms, it can reduce the severity of physical symptoms.[13] In addition, counselling and psychological intervention for PMS, including patient education, supportive therapy and behavioural changes have proven to be beneficial for some women. Women educated about the biologic basis and prevalence of PMS report an increased sense of control and relief of symptoms.[14] In three to eight percent of all women, the symptoms of PMS are so severe and disruptive that medical intervention is required and selective serotonin reuptake inhibitors (SSRIs) – antidepressants such as Sertraline, Fluoxetine or Paroxetine – are prescribed.[15] This is a diagnosed medical condition called Premenstrual Dysphoric Disorder (PMDD).

PMS after childbirth

It’s not necessarily good news for mums hoping to be done with the symptoms of PMS after childbirth. In fact, research reveals that the severity of PMS symptoms have a tendency to increase postpartum.[16] After birth, many women experience heavy, painful or irregular periods and mood swings. Which is not surprising, given the chaos wreaked on hormones from pregnancy, childbirth and breastfeeding. Add to the mix sleep deprivation, adrenal fatigue or postpartum depression and it can result in a real game-changer when it comes to the menstrual cycle.[17] There’s currently very little scientific research into the reasons why this might occur, but scientists argue that the effect of oestrogen and progesterone levels on the brain, and in particular on serotonin levels – the happy hormone – after the physical and hormonal upheaval of pregnancy, birth and breastfeeding might be at play.[18]

What is PMDD?

The most severe form of PMS is premenstrual dysphoric disorder (PMDD). This is a medically diagnosed condition that affects approximately three to eight percent of all menstruating women. The symptoms of PMDD are significantly more severe than those of PMS and have a very serious impact on a woman’s quality of life and relationships. They include:[19]

no interest in daily activities and relationships

fatigue or low energy

feeling of sadness or hopelessness, possible suicidal thoughts

feelings of tension or anxiety

feeling of being out of control

food cravings or binge eating

mood swings with periods of crying

panic attacks

irritability or anger that affects other people

physical symptoms, such as bloating, breast tenderness, headaches, and joint or muscle pain

problems sleeping

trouble concentrating

PMDD is particularly difficult to diagnose because it’s vital for doctors to be certain that symptoms aren’t merely exacerbations of symptoms of another disorder such as major depressive disorder, panic disorder, dysthymic disorder or a personality disorder (although it may be superimposed on any of these disorders).[20] There are no specific physical examinations or lab tests that can diagnose PMDD so women must keep a diary of symptoms to help identify the most troublesome symptoms and when they occur.[21] The symptoms diary is then compared with the menstrual calendar to illustrate the relationship of symptoms to the menstrual cycle.[22] Once diagnosed, PMDD is treated predominantly with prescribed SSRIs (Selective Serotonin Reuptake Inhibitor) – antidepressants such as Sertraline, Fluoxetine or Paroxetine.[23] Other treatments that may help include:[24]

birth control pills

diuretics, which may be useful for women who gain a lot of weight from fluid retention

nutritional supplements such as vitamin B6, calcium and magnesium

other medicines (such as Lupron Depot) that suppress the ovaries and ovulation

pain relievers such as paracetamol or ibuprofen that may be used to relieve headache, backache, menstrual cramping and breast tenderness.